Use of Traditional, Complementary

and Alternative Medicine (TCAM):

A Case Study of Indian Cancer
Patients

Prem Chhetri RMIT University &

Dr Alex Broom
the University of Newcastle
 Content
► Background

► Concept of TCAM

► Research Methodology

► Data collection

► Results and Interpretation

► Discussion
 Background
► In
2005 cancer killed approximately
826,000 people in India; 519,000
under the age of 70 (WHO, 2005).

► Thisis predicted to rise

disproportionally compared with
cardiovascular and communicable
diseases by 2030 to nearly 1.5 million
deaths annually.
 Background
► The Indian subcontinent is home to 16.5 percent of the
world’s population and at any one time it is estimated that
there are over 2 million people with cancer (Kishore et al
2008).

► The majority of Indian cancer patients have late stage

incurable disease (75% to 80%) when first diagnosed
(Jones, 1999; Kishore et al, 2008; Kumar & Mittal, 2004;
Pal, 2002).

► At present, out of one million newly diagnosed Indian

cancer patients each year, more than 50 percent will die
within 12 months of diagnosis and another one million
cancer survivors (within 5 years of diagnosis) will show
progressive disease (Pal & Mittal, 2004).
Background: TCAM and global health
► Global health policy emphasising the importance of
promoting traditional medicines (TM) to help
address the range of health concerns facing poorer
countries

► Traditional medicines could (and do) play a role in

reducing excess mortality and morbidity in poor and
marginalised populations

► Recent policy trajectory has been toward a melding

of traditional and biomedical systems

► But are there implications of the promotion of TM?

(source: WHO, 2001)
 Many traditional, complementary and
alternative practices
► Examples in South Asia:
 Ayurveda (Hindu)
 Unani medicine - Hakim (Islamic)
 Spiritual healers, Dam - Pirs (Islamic)
 Traditional Chinese Medicine (China and used
throughout Asia)
 Homeopathy (imported from Europe, popular
in India)

► Participants shifted between alternative and

traditional, few used complementary.
 Traditional Medicines
► TCAM generally refers to health care practices not
offered within orthodox facilities (or by their
practitioners).

► Traditionalmedicine (TM) refers to local indigenous

practices and belief systems that are used in
developing countries for health-related purposes
(Bodeker & Kronenberg, 2002).

► TMs have often been the dominant means of

treatment for health problems for centuries (e.g.
Ayurveda and Unani in India), and in some cases,
they continue to dominate health care beliefs and
practices.
Complementary and Alternative
Medicine
►Complementary and alternative
medicine (CAM) is generally used to
refer to a range of non-indigenous,
unorthodox practices including
homeopathy, naturopathy, herbalism
and so on (Broom and Tovey, 2008).
 Purpose
► The aim of this project is two fold:
 i) first to identify socio-demographic
and disease status differences
between the TCAM and non-TCAM
users among cancer patients in India
and
 ii) second to assess whether there is
a difference in seeking help from
‘orthodox medicine’ between the
groups.
 Data Collection
► Survey of 825 cancer patients in public and private
hospitals in Delhi. The survey was conducted over the
course of four months and the response rate was 80%.

► Recruitment sites:
 All India Institute of Medical Sciences
 Rajiv Ghandi Cancer Institute

► Using four interviewers, we used list sampling to interview

every second patient over this four month period.

► 90 percent of the interviews were done in Hindi and 10

percent in English.
Data Collection
 Results
► Of the entire sample, 34.3% used TCAM
representing a significant proportion of the
population.
► The most common types of practices used in this
cohort of patients were Ayurveda, Homeopathy,
Meditation, Acupuncture and Reiki.
► 22.8% had used local TM practices (e.g.
Ayurveda) and 25.5% used CAM (e.g.
Homeopathy).
► Of the 34.3% of TCAM users, 13.9% used both
local TM and non-indigenous CAM.
 TCAM User’s Profile
► TCAM users are more likely to be relatively older
private patients, they are tended to be married
upper caste Hindu, generally residing in Delhi or
its surrounding states.
► Non-users of TCAM are more likely to be male.
Furthermore, non-users were more likely to be
single, public patients and non-Hindu in
comparison to TCAM users.
► Non-users also tend to travel longer distance for
their treatment (14.8% for TCAM users as
compare to 21.6% for non-users).
 Delay in seeking help from
orthodox medicine
► 35.2% of respondents using TCAM sought
help immediately after onset of symptoms
whereas 50% of non-users immediately
sought help from orthodox medicine.

► 12.8%of TCAM users waited 3 months or

more after noticing symptoms whereas only
4.3% of non-users waited this long.
 delay in seeking help from
orthodox medicine
Delays in seeking help: TCAM Non-Users
Users
One week 35.2% 50.0% 0.000* *
One month 9.7% 6.8%

Three months 30.8% 36.8%

More than 3 months 12.8% 4.3%

► Arewomen more likely to be treated with
TCAM?

Crosstab

Us e of CAM or TM
Yes No Total
Sex Male Count 137 302 439
% within Sex 31.2% 68.8% 100.0%
Female Count 146 240 386
% within Sex 37.8% 62.2% 100.0%
Total Count 283 542 825
% within Sex 34.3% 65.7% 100.0%
► Do women more likely to use public or
private hospitals?
Crosstab

Us e of CAM or TM
Public /Private Yes No Total
Public Sex Male Count 19 162 181
% within Sex 10.5% 89.5% 100.0%
Female Count 11 128 139
% within Sex 7.9% 92.1% 100.0%
Total Count 30 290 320
% within Sex 9.4% 90.6% 100.0%
Private Sex Male Count 118 140 258
% within Sex 45.7% 54.3% 100.0%
Female Count 135 112 247
% within Sex 54.7% 45.3% 100.0%
Total Count 253 252 505
% within Sex 50.1% 49.9% 100.0%

For TCAM Users For Non TCAM

Users
► Is there a difference between the treatment
received by non-upper caste women?
Crosstab

Us e of CAM or TM
Caste recode Yes No Total
Upper cas te Sex Male Count 84 204 288
% within Sex 29.2% 70.8% 100.0%
Female Count 94 181 275
% within Sex 34.2% 65.8% 100.0%
Total Count 178 385 563
% within Sex 31.6% 68.4% 100.0%
Others Sex Male Count 28 76 104
% within Sex 26.9% 73.1% 100.0%
Female Count 19 33 52
% within Sex 36.5% 63.5% 100.0%
Total Count 47 109 156
% within Sex 30.1% 69.9% 100.0%

For TCAM Users

 Conclusion
► We found that TCAM and Non-TCAM users
are different in terms of their socio-
demographic characteristics

► We also found that TCAM users tend to

delay in Orthodox medicinal treatment that
might have strong implication in treatment.

► Female participants are more likely to be

treated with TCAM, but they are more likely
to be presented at private hospitals
 What next?
► Requires more advanced statistical analysis and
modelling to ascertain the factors affecting the use
of TCAM

► Combining the results of qualitative data analysis

and cross validation.

► Comparing results from different parts of South

Asia

► Establishing a broader theoretical framework of

the analysis